Caesarian Section in a Collapsed Society

I’m confident that when things go splat, I’ll be able to do the tasks, cook the food, ascertain the disease, etc., if I have covered it on the blog.  As long as I have the supplies and the procedure written down.  I don’t really want to make medical maggots, but I think I could pull it off.  I’m not so confident about performing a Caesarean section.  Which is probably a good thing.  I haven’t gone to med school yet.  And at this age, it isn’t likely to happen in this lifetime.

All the other off-grid medical texts only indicate that a woman in need of a c-section must get to a hospital.  We all already know that much.  We also know that if a woman in need of a c-section cannot get it, she will die. 

Survival and Austere Medicine, 3^rd Edition, provides the following information. 

“Whether this is an option for you is very much dependent on your skills and your ability to give an anaesthetic—either general or local.  Untrained people attempting something like this is high risk.  Decision making around surgical practice in grid-down-high risk circumstances is discussed in more detail in the surgery chapter.  Obstetric anaesthesia is high risk even in the hands of an expert.  A couple of general points:

• It is possible to perform a caesarean section under local anaesthesia (local infiltration as opposed to spinal or epidural anaesthesia) with and without sedation.  How practical this is depends to a degree on the mental state of the woman.  While removing most of the pain sensation, it does not remove the sensation of pushing and pulling associated with handling the internal organs.  This can be a very unpleasant sensation for some women.  However, evidence from Africa suggests that it is a viable option in a low-tech environment.
• The standard incision for a caesarean section is a horizontal lower abdominal incision followed by a horizontal incision over the lower segment of the uterus.  This results in a stronger scare on the uterus and a better cosmetic skin incision; however, it is not the easiest approach.  In an austere situation the skin incision of choice is a large up/down incision over the body of the uterus, the so called “classical” incision.  This approach is considerably easier for the novice from an operative point of view.  The scar on the uterus is not nearly as strong, though, and there is a significant risk of rupture if the woman subsequently goes through another labor.  Aseptic technique and sterile operating equipment is a must with this procedure, and if bypassed will leave the mother in grave danger.  Antibiotics are certainly indicated, if possible."[1]

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[1] Survival and Austere Medicine, 3^rd Edition, 2017, 288.